Autoantibodies against the endothelial receptor of protein C are associated with acute myocardial infarction in young women

BACKGROUND: Acute myocardial infarction (AMI) is rare among young women. The search for unknown risk factors is warranted. Endothelial protein C receptor (EPCR) is largely present at the endothelial surface of large arteries. No studies about association of anti-EPCR autoantibodies (anti-EPCR) with AMI are available. METHODS: Plasma IgA, IgM and IgG anti-EPCR levels were measured by enzyme-linked immunosorbent assay in 165 women younger than 45 years who survived a first AMI and 165 healthy women, matched by age and geographical origin. RESULTS: Using the 90th percentile of IgA anti-EPCR in the control group, IgA anti-EPCR were independently associated with AMI after adjustment for cardiovascular risk factors (OR 5.1; 95% CI 1.7-15.6; P = 0.004). The risk apparently conferred by IgA anti-EPCR increased dose-dependently (P for trend =0.0002). IgM anti-EPCR were less consistently associated with AMI: a significant increase in the risk was found when women above the 90th percentile were compared with those in the lowest quartile (OR 3.6; 95% CI 1.2-11.5; P = 0.03). IgG anti-EPCR were similar in patients and controls. A total of 145 patients underwent coronary arteriography. IgA or IgM anti-EPCR were not different among patients with different degrees of atherosclerotic lesion (anova, P = 0.77 and 0.24, respectively). CONCLUSIONS: High levels of IgA and, to a lesser extent, IgM anti-EPCR, are associated with AMI in young women

D-dimer testing, with gender-specific cutoff levels, is of value to assess the individual risk of venous thromboembolic recurrence in non-elderly patients of both genders: a post hoc analysis of the DULCIS study

Male patients, especially the young, are at a higher risk of recurrent venous thromboembolism (RVTE) than females. Recent scientific reports show the use of D-dimer does not help predict RVTE risk in males. In the present report, we reviewed the data obtained in the DULCIS study (main report published in Blood 2014), focusing on D-dimer results recorded in non-elderly patients of both genders included in the study, and their relationship with RVTE events occurring during follow-up. Using specifically designed cutoff values for positive/negative interpretation, serial D-dimer measurements (performed during warfarin treatment and up to 3 months after discontinuation of anticoagulation) in 475 patients (males 57.3%) aged 64 65 years were obtained. D-dimer resulted positive in 46.3% and 30.5% of males and females, respectively (p = 0.001). Following management procedure, anticoagulation was stopped in 53.7% of males and 69.5% of females, who had persistently negative D-dimer results. The rate of subsequent recurrent events was 1.7% (95% CI 0.5\u20134.5%) and 0.4% (95% CI 0\u20132.5%) patient-years in males and females, respectively, with upper limits of confidence intervals always below the level of risk considered acceptable by international scientific societies for stopping anticoagulation (< 5%). In conclusion, using sensitive quantitative assays with specifically designed cutoff values and serial measurements during and after discontinuation of anticoagulation, D-dimer testing is useful to predict the risk of RVTE and is of help in deciding the duration of anticoagulation in both male and female adult patients aged up to 65 years

No evidence of association between prothrombotic gene polymorphisms and the development of acute myocardial infarction at a young age

Background : we investigated the association between 9 polymorphisms of genes encoding hemostasis factors and myocardial infarction in a large sample of young patients chosen because they have less coronary atherosclerosis than older patients, and thus their disease is more likely to be related to a genetic predisposition to a prothrombotic state Methods and Results : this nationwide case-control study involved 1210 patients who had survived a first myocardial infarction at an age of 45 years who underwent coronary arteriography in 125 coronary care units and 1210 healthy subjects matched for age, sex, and geographical origin. None of the 9 polymorphisms of genes encoding proteins involved in coagulation (G-455A -fibrinogen: OR, 1.0; CI, 0.8 to 1.2; G1691A factor V: OR, 1.1; CI, 0.6 to 2.1; G20210A factor II: OR, 1.0; CI, 0.5 to 1.9; and G10976A factor VII: OR, 1.0; CI, 0.8 to 1.3), platelet function (C807T glycoprotein Ia: OR, 1.1; CI, 0.9 to 1.3; and C1565T glycoprotein IIIa: OR, 0.9; CI, 0.8 to 1.2), fibrinolysis (G185T factor XIII: OR, 1.2; CI, 0.9 to 1.6; and 4G/5G plasminogen activator inhibitor type 1: OR, 0.9; CI, 0.7 to 1.2), or homocysteine metabolism (C677T methylenetetrahydrofolate reductase: OR, 0.9; CI, 0.8 to 1.1) were associated with an increased or decreased risk of myocardial infarction Conclusions : this study provides no evidence supporting an association between 9 polymorphisms of genes encoding proteins involved in hemostasis and the occurrence of premature myocardial infarction or protection against it

Disturbi psichici associabili a condizioni di lavoro negative persistenti

Tra il 2004 e il 2010 sono giunti alla nostra osservazione 449 lavoratori per una valutazione che doveva stabilire se le condizioni di lavoro fossero state la causa dei disturbi psichici di cui erano affetti. Ciascun lavoratore \ue8 stato esaminato da un medico del lavoro che ha raccolto approfondite informazioni anamnestiche sia sulle condizioni di lavoro che sullo stato di salute, con particolare riferimento alle patologie della sfera psichica, tenendo anche conto delle eventuali situazioni pre-esistenti ai problemi lavorativi. L\u2019accertamento \ue8 stato approfondito quindi da uno psicologo clinico, che tramite un colloquio e la somministrazione di test psico-diagnostici, ha completato la sua valutazione. Al termine degli accertamenti il medico del lavoro e lo psicologo clinico concordavano la diagnosi e si esprimevano sulla possibile relazione tra la psicopatologia riscontrata e le condizioni lavorative. Risultati: In 379 casi, su 449 pervenuti, abbiamo ritenuto che le condizioni di lavoro avessero fornito un contributo determinante per la comparsa dei disturbi psichici. I disturbi mentali rilevati erano i seguenti: il disturbo ansioso-depressivo nel 53,6% dei casi, il disturbo depressivo nel 16,2%, il disturbo dell\u2019adattamento nel 15,9%, il disturbo d\u2019ansia nel 13% e solo in rari casi il disturbo post-traumatico da stress (1,3%). Le condizioni di lavoro negative, causa dei disturbi diagnosticati, erano rappresentate da molestie morali protratte in ambiente di lavoro riferite prevalentemente alla persona (person-related bullying) nel 30,1% dei casi oppure solo agli aspetti lavorativi, condizione definita con il termine costrittivit\ue0 organizzative, (task-related bullying) nel 14,8%, da situazioni avverse favorenti il distress lavorativo (38,2%) e da circostanze in grado di indurre disagio lavorativo aspecifico (16,9%)

Metabolic effects of lisinopril versus hydrochlorothiazide plus amiloride in essential hypertension

A multicenter, randomized, double-blind, parallel-group trial was conducted to compare the effects of long-term treatment with lisinopril versus hydrochlorothiazide plus amiloride on lipids, glucose, uric acid, and electrolytes in patients with mild to moderate essential hypertension. After 6 months of treatment with hydrochlorothiazide 50 to 100 mg plus amiloride 5 to 10 mg or lisinopril 10 to 20 mg given once daily, the patients receiving the diuretics showed an increase in triglycerides, very-low-density lipoproteins, and apolipoproteins A and B, while the patients receiving lisinopril had only minimal changes in these parameters and an increase in high-density lipoproteins. Serum uric acid levels rose significantly in the group receiving diuretics but did not change in the lisinopril group. The antihypertensive effect was similar for both drug regimens. These data show that the long-acting angiotensin converting enzyme inhibitor lisinopril did not induce any metabolic effects and should be preferred, as a first choice, to antihypertensive drugs such as diuretics, which may cause lipid and uric acid metabolism disorders